Bolus Imaging

ABSTRACT

A system and method includes detection of a trigger event, automatic injection, in response to detecting the trigger event, of a bolus of contrast medium into a patient volume after expiration of a predetermined injection delay period, automatic acquisition, in response to detecting the trigger event, of a plurality of images after expiration of a predetermined imaging delay period, where two or more of the plurality of images comprise an image of the bolus at respective different locations within vasculature of the patient volume, generation of a composite image based on the plurality of images, the composite image including a representation of the vasculature of the patient volume, and display of the composite image.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a continuation application of U.S. patentapplication Ser. No. 15/825,002, filed Nov. 28, 2017, which claimsbenefit of EP Application No. 16205405.0, filed Dec. 20, 2016, theentire contents of which are herein incorporated by reference.

BACKGROUND

According to conventional angiographic x-ray imaging, contrast media areused to enhance the contrast of blood-carrying structures within patientanatomy. For example, a contrast medium is introduced into a patientvolume (e.g., via intravenous injection) and an x-ray image of thevolume is acquired while the medium resides within blood-carryingstructures of the volume. In the x-ray image, structures which containthe medium (e.g., veins, arteries, capillaries) appear darker than theywould otherwise appear.

Systems are desired for generating images of patient vasculature usingreduced amounts of contract media.

BRIEF DESCRIPTION OF THE DRAWINGS

The construction and usage of embodiments will become readily apparentfrom consideration of the following specification as illustrated in theaccompanying drawings, in which like reference numerals designate likeparts, and wherein:

FIG. 1 illustrates a system according to some embodiments;

FIG. 2 is a flow diagram of a process according to some embodiments;

FIG. 3 includes a timing diagram according to some embodiments;

FIG. 4 illustrates x-ray images acquired according to some embodiments;

FIG. 5 illustrates a composite x-ray image according to someembodiments;

FIG. 6 illustrates a composite x-ray image according to someembodiments;

FIG. 7 is a flow diagram of a process according to some embodiments;

FIG. 8 includes a timing diagram according to some embodiments;

FIG. 9 illustrates a cardiac cycle.

FIG. 10 illustrates a composite x-ray image according to someembodiments;

FIG. 11 illustrates a composite x-ray image according to someembodiments;

FIG. 12 illustrates a composite x-ray image according to someembodiments;

FIG. 13 illustrates looping composite x-ray images according to someembodiments;

FIG. 14 illustrates looping composite x-ray images according to someembodiments; and

FIG. 15 illustrates generation of a composite x-ray image according tosome embodiments.

DETAILED DESCRIPTION

The following description is provided to enable any person in the art tomake and use the described embodiments and sets forth the best modecontemplated for carrying out the described embodiments. Variousmodifications, however, will remain readily apparent to those in theart.

Some embodiments facilitate the generation of images of patientvasculature. According to some embodiments, a small bolus of contrastmedium is injected intravenously and images are acquired insynchronization with the injection. The images are then combined tocreate a composite image which portrays the vasculature through whichthe small bolus traveled during acquisition of the images. The imagesmay be acquired over several cardiac cycles, in which case thesynchronization may take into account the length and/or phases of thecardiac cycle.

FIG. 1 illustrates system 1 according to some embodiments. System 1includes x-ray imaging system 10, control and processing system 20, andoperator terminal 30. Generally, and according to some embodiments,x-ray imaging system 10 introduces contrast medium into a patient volumeand acquires x-ray images of the patient volume. Control and processingsystem 20 controls x-ray imaging system 10 and receives the acquiredimages therefrom. Control and processing system 20 processes the imagesas described below and provides the processed images to terminal 30 fordisplay thereby. Such processing may be based on user input received byterminal 30 and provided to control and processing system 20 by terminal30.

X-ray imaging system 10 comprises C-arm 11 on which radiation source 12and radiation detector 13 are mounted. C-arm 11 is mounted on support 14and is configured to translate clockwise or counter-clockwise withrespect to support 14. This translation rotates radiation source 12 andradiation detector 13 around a central volume while maintaining thephysical relationship therebetween. Embodiments are not limited toC-arm-based imaging systems.

Radiation source 12 may comprise any suitable radiation source,including but not limited to a Gigalix™ x-ray tube. In some embodiments,radiation source 12 emits electron, photon or other type of radiationhaving energies ranging from 50 to 150 keV.

Radiation detector 13 may comprise any system to acquire an image basedon received x-ray radiation. In some embodiments, radiation detector 13is a flat-panel imaging device using a scintillator layer andsolid-state amorphous silicon photodiodes deployed in a two-dimensionalarray. The scintillator layer receives photons and generates light inproportion to the intensity of the received photons. The array ofphotodiodes receives the light and records the intensity of receivedlight as stored electrical charge.

In other embodiments, radiation detector 13 converts received photons toelectrical charge without requiring a scintillator layer. The photonsare absorbed directly by an array of amorphous selenium photoconductors.The photoconductors convert the photons directly to stored electricalcharge. Radiation detector 13 may comprise a CCD or tube-based camera,including a light-proof housing within which are disposed ascintillator, a mirror, and a camera.

The charge developed and stored by radiation detector 13 representsradiation intensities at each location of a radiation field produced byx-rays emitted from radiation source 12. The radiation intensity at aparticular location of the radiation field represents the attenuativeproperties of tissues lying along a divergent line between radiationsource 12 and the particular location of the radiation field. The set ofradiation intensities acquired by radiation detector 13 may thereforerepresent a two-dimensional projection image of these tissues.

Contrast injector 17 may comprise any known device or devices suitableto controllably introduce contrast medium into a patient volume. Suchcontrol includes control over the timing, the rate, and the quantity ofintroduced contrast medium. As described above, structures which containcontrast medium appear darker in x-ray images than they would otherwiseappear. Conversely, if a “negative” contrast agent (e.g., CO₂) is used,structures which contain contrast medium appear lighter in x-ray imagesthan they would otherwise appear. Contrast injector 17 may include areservoir for each of one or more contrast media, and a patientinterface such as medical-grade tubing terminating in a hollow needle.

Cardiac monitor 18 may comprise any known system to detect cardiacsignals of patient 15. Cardiac monitor 18 may be coupled to patient 15via one or more electrodes. Cardiac monitor 18 may comprise anelectrocardiograph according to some embodiments.

System 20 may comprise any general-purpose or dedicated computingsystem. Accordingly, system 20 includes one or more processors 21configured to execute processor-executable program code to cause system20 to operate as described herein, and storage device 22 for storing theprogram code. Storage device 22 may comprise one or more fixed disks,solid-state random access memory, and/or removable media (e.g., a thumbdrive) mounted in a corresponding interface (e.g., a USB port).

Storage device 22 stores program code of system control program 23. Oneor more processors 21 may execute system control program 23 to moveC-arm 14, to cause radiation source 12 to emit radiation, to controldetector 13 to acquire an image, to cause injector 17 to introducecontrast medium into a volume of patient 15, and to perform any otherfunction. In this regard, system 20 includes x-ray system interface 24,contrast injector interface 25, and cardiac monitor interface 29 forcommunication with system 10.

Images acquired from system 10 are stored in data storage device 22 asacquired images 26, in DICOM or another data format. Each acquired image26 may be further associated with details of its acquisition, includingbut not limited to imaging plane position and angle, imaging position,radiation source-to-detector distance, patient anatomy imaged, patientposition, contrast medium bolus injection profile, x-ray tube voltage,image resolution and radiation dosage.

Processor(s) 21 may execute system control program 23 to processacquired images 26, resulting in processed images 27. Processed images27 may be provided to terminal 30 via UI interface 28 of system 20. UIinterface 28 may also receive input from terminal 30, which is used tocontrol processing of acquired images 26 as described below.

Terminal 30 may simply comprise a display device and an input devicecoupled to system 20. Terminal 30 displays acquired images 26 and/orprocessed images 27 received from system 20 and may receive user inputfor controlling display of the images, operation of imaging system 10,and/or the processing of acquired images 26. In some embodiments,terminal 30 is a separate computing device such as, but not limited to,a desktop computer, a laptop computer, a tablet computer, and asmartphone.

Each of system 10, system 20 and terminal 30 may include other elementswhich are necessary for the operation thereof, as well as additionalelements for providing functions other than those described herein.

According to the illustrated embodiment, system 20 controls the elementsof system 10. System 20 also processes images received from system 10.Moreover, system 20 receives input from terminal 30 and providesprocessed images to terminal 30. Embodiments are not limited to a singlesystem performing each of these functions. For example, system 10 may becontrolled by a dedicated control system, with the acquired images beingprovided to a separate image processing system over a computer networkor via a physical storage medium (e.g., a DVD).

FIG. 2 is a flow diagram of process 200 according to some embodiments.Process 200 and the other processes described herein may be performedusing any suitable combination of hardware, software or manual means.Software embodying these processes may be stored by any non-transitorytangible medium, including a fixed disk, a floppy disk, a CD, a DVD, aFlash drive, or a magnetic tape. Examples of these processes will bedescribed below with respect to the elements of system 1, butembodiments are not limited thereto.

It will be assumed that, prior to S210, the patient is positioned forimaging according to known techniques. For example, and with referenceto the elements of system 1, patient 15 is positioned on table 16 toplace a particular volume of patient 15 between radiation source 12 andradiation detector 13. Table 16 may be adjusted to assist in positioningthe patient volume as desired. As is known in the art, such positioningmay be based on a location of a volume of interest, on positioningmarkers located on patient 15, on a previously-acquired planning image,and/or on a portal image acquired after an initial positioning ofpatient 15 on table 16.

Initially, at S210, a trigger event is detected. Detection of thetrigger event may comprise reception of an instruction from an operatorof terminal 30 to commence imaging a patient, or detection of a physicalstate of the patient, such as but not limited to maximum exhalation(i.e., a state associated with reduced respiration-induced vesselmotion).

At S220, it is determined whether an injection delay period has expired.The injection delay period is a time period which is to pass after atrigger event before commencing injection of a bolus of contrast medium.The injection delay period may be zero, or may be set to an amount,based on the nature of the trigger event, which attempts to minimizevessel motion during image acquisition. Flow cycles at S220 until theinjection delay period has expired.

Contemporaneously, at S230, it is determined whether an imaging delayperiod has expired. The imaging delay period is a time period which isto pass after a trigger event before commencing image acquisition. Theimaging delay period may be set equal to the injection delay period,less than the injection delay period (e.g., to ensure that an imageframe is acquired without contrast medium), or greater than theinjection delay period (e.g., to ensure that only image frames withcontrast medium are acquired). Flow cycles at S230 until the imagingdelay period has expired.

Flow proceeds from S220 to S240 after determining that the injectiondelay has expired. A bolus of contrast medium is injected into thepatient at S240. The duration of the bolus injection is determined basedon the desired width of the bolus in the to-be-acquired images. The flowrate of the injection may be selected such that the incoming contrastmedium blocks blood flow during the duration of the bolus injection(i.e., the injection flow rate is greater than the flow rate of blood inthe vessel(s) being imaged).

The injection duration and injection flow rate determine the quantity ofinjected contrast medium. Accordingly, the quantity of injected contrastmedium may be reduced by reducing either or both of these parameters.However, due to the dependence of the injection flow rate on the bloodflow rate according to some embodiments, it may be preferable to reducethe required quantity of contrast medium by selecting an injectionduration (i.e., a bolus width) which is as short as needed to result ina suitable composite image, as will be described below.

According to some embodiments of S240, system 20 instructs contrastinjector 17 to introduce the bolus of contrast medium into an artery ofpatient 15. The parameters of the medium introduction (e.g., duration,flow rate, location, volume) may be controlled by system control program23.

FIG. 3 is a timing diagram illustrating a trigger event, a bolusinjection and x-ray imaging according to some embodiments. As shown, thebolus injection is delayed from the trigger event by an injection delayperiod t_(bp). The acquisition of x-ray images is delayed from thetrigger event by an imaging delay period t_(xp). As described above,these periods need not be of equal duration according to someembodiments. The duration of bolus injection is shown as period t_(bw).As also described above, period t_(bw) may be selected to provide asuitable bolus width within the acquired images according to someembodiments.

In this regard, and returning to process 200, an x-ray image is acquiredat S250 after the imaging delay is determined to have expired at S230.Acquisition of the image is represented by line 310 of FIG. 3. Accordingto some embodiments of S250, C-arm 11 is positioned so that radiationsource 12 and radiation detector 13 are disposed at a predeterminedprojection angle with respect to the patient volume. Radiation source 12is instructed to emit x-ray radiation toward radiation detector 13 basedon parameters (e.g., x-ray tube voltage, dosage) controlled by systemcontrol program 23 as is known in the art. Radiation detector 13receives the emitted radiation and produces a set of data (i.e., aprojection image) at S250. The projection image may be received bysystem 20 and stored among acquired images 26.

At S260, it is determined whether additional images are to be acquired.This determination may be based on a predetermined plan which specifiesa number of images and their respective timings, and/or a predeterminedimaging time period during which images are to be acquired at regularintervals. If additional images are to be acquired, flow returns to S230to wait for an imaging interval associated with a next image to beacquired.

The timing diagram of FIG. 3 illustrates imaging interval t_(xd)according to some embodiments. Flow pauses at S230 for interval t_(xd)prior to acquiring a next image at S250. The duration of imaging periodt_(xw) may be set to substantially equal a time required for the bolusto pass through the region of interest. As shown in the timing diagram,flow returns from S260 to S230 and S250 twenty-one additional times toacquire twenty-one additional images at the illustrated timings. Flowadvances to S270 after a last image is acquired.

A composite image is generated from two or more of the acquired imagesat S270. According to some embodiments, all of the acquired images areused in the generation of the composite image. The composite image may,in some embodiments, provide an indication of the vasculature throughwhich the bolus traveled during acquisition of the images. The compositeimage may be stored among composite images 27 of storage device 22.

According to some embodiments, the acquired images are registered withone another during generation of the composite image at S270.Registration is intended to remove motion artifacts between the imagesof a pair, by correcting for any relative motion of the patient betweenacquisitions of the images of the pair. Any motion correction techniquemay be employed at S270. Moreover, visual characteristics of the imagesmay be matched at S270. Such matching may include modifying one or moreimages to match a brightness, contrast, signal strength and/or othervisual characteristic of another image. S270 may comprise histogrammatching in some embodiments.

FIG. 4 illustrated images 410 through 480 which are acquired at S250according to an example of some embodiments. Image 410 may comprise afirst image acquired at S250 after detection of a trigger event andexpiration of the imaging delay period. Image 410 depicts injectionneedle 400 and bolus 405. As described above, a duration period t_(bw)of the bolus injection may have been determined so as to create bolus405 of width w.

Image 420 is assumed to have been acquired after an imaging delay periodt_(xd). Accordingly, bolus 405 has advanced through the imaged patientvolume, presumably along a path of an artery in which bolus 405 resides.It should be noted that the width, height and/or shape of bolus 405 maydiffer among the acquired images due to dispersal of the contrastmedium, or due to change in the shape of the vasculature cross-sectionin the plane of the image. Such a change in shape may comprise an actualwidening or narrowing of the vasculature or “foreshortening” caused byvariations in the skew of the vasculature with respect to the plane ofthe image.

Image 430 illustrates the break-up of bolus 405 into portions 405 a and405 b due to branching of the vasculature. Images 440, 450 and 460,acquired successively over time, depict further movement of bolusportions 405 a and 405 b. Lastly, images 460, 470 and 480 depict furtherbreak-up of portions 405 a and 405 b into portions 405 a 1, 405 a 2, 405b 1 and 405 b 2 and movement thereof according to some embodiments.

FIG. 5 illustrates composite image 500 according to some embodiments.Composite image 500 is generated at S270 by combining images 410 through480. Composite image 500 provides a representation of the vasculaturethrough which bolus 405 passed during the imaging process. As shown, thedistance traveled by bolus 405 between the acquisition of images (i.e.,during interval t_(xd)) is greater than the width w of bolus 405.Accordingly, composite image 500 includes gaps.

In contrast, composite image 600 was generated based on images for whichthe imaging interval t_(xd) was less than a time required for bolus 405to travel a distance w. As a result, each image of bolus 405 from one ofthe acquired images overlaps an image of bolus 405 from asuccessively-acquired image. Composite image 600 therefore includes nogaps.

Any algorithm for creating an image based on two or more images may beemployed at S270. For example, according to some embodiments, a value ofeach pixel of composite image 500 or composite image 600 is equal to themaximum value of corresponding pixels of each acquired image (i.e.,C_(x,y)=Max [A1_(x,y), A2_(x,y), . . . , An_(x,y)]). In someembodiments, the value of each pixel is a weighted sum of correspondingpixels such as C_(x,y)=wA_(x,y)+(1−w)V_(x,y).

Accordingly, some embodiments efficiently provide a representation ofpatient vasculature while reducing patient exposure to contrast mediumwith respect to conventional systems.

According to some embodiments, a two-dimensional mask image is acquiredat the imaging projection angle prior to the detection of the triggerevent at S210. Since the mask image is acquired without the presence ofthe contrast medium, the mask image depicts background anatomic detailof the patient volume. The mask image may be registered with andsubtracted from each of the acquired images prior to combination thereofat S270. The resulting composite image portrays only the vesselcomponents of the patient volume which include contrast medium. Anyother processing may be applied to the acquired images prior togeneration of the composite image based thereon.

Similarly, any processing that is or becomes known may be applied to thecomposite image such as, but not limited to, edge enhancement,brightness adjustment, field of view collimation, and conformance of theimage to the display properties of the display device of terminal 30.Processing at S270 may include one or more of denoising filters, medianfilters and low-pass filters.

Process 700 of FIG. 7 provides vascular imaging according to someembodiments. Process 700 may facilitate imaging of the heart muscle atrest. According to some embodiments, a small bolus of contrast medium isinjected and images are acquired as the bolus moves through patientvasculature. Moreover, the images are acquired during rest periods ofthe cardiac cycle.

A patient is positioned for imaging prior to S710 according to knowntechniques. Flow pauses at S710 until a trigger event is detected.According to some embodiments, detection of the trigger event maycomprise detection of an R-wave peak in an electrocardiogram signalreceived from cardiac monitor 18.

At S720, it is determined whether an injection delay period has expired.As described with respect to S220 of process 200, flow cycles at S720until the injection delay period has expired. A bolus of contrast mediumis injected into the patient at S730 after expiration of the injectiondelay period, based on a duration and flow rate determined as describedabove.

FIG. 8 is a timing diagram illustrating a trigger event and an injectiondelay period according to some embodiments of process 700. The bolusinjection at S730 is delayed from the trigger event by an injectiondelay period t_(bp0). Process 700 may employ several injection delayperiods, which will be generally labelled as t_(bpN). The duration ofbolus injection is shown as period t_(bw). As described above, periodt_(bw) may be selected to provide a suitable bolus width within theacquired images according to some embodiments.

Also in response to detection of the trigger event, it is determined atS740 whether an imaging delay period has expired. X-ray images areacquired at S750 after expiration of the imaging delay period. As shownin FIG. 8, the acquisition of x-ray images at S750 occurs over imagingperiod t_(xw) at imaging interval t_(xd) and is delayed from the triggerevent by an imaging delay period t_(xp). As described above, t_(xp) andt_(bpN) need not be of equal duration according to some embodiments.

Some embodiments of process 700 attempt to acquire images during a restperiod of the cardiac cycle. In this regard, as illustrated with respectto cardiac cycle 900 of FIG. 9, t_(xp) may be set based on the delaybetween the R-wave peak and the start of the S-T segment. Moreover, theimaging period t_(xw) may be set based on the duration of the S-Tsegment.

A single imaging period t_(xw) might not provide sufficient time for thebolus to travel through the entire structure of interest. Accordingly,it may be determined to acquire more images at S760 to ensure that theentire structure is imaged. If so, flow returns to S710 to detect a nexttrigger event (e.g., the R-wave peak) and to acquire a second set ofimages based on the imaging delay period t_(xp) and the imaging periodt_(xw) as described above. FIG. 8 illustrates such an acquisition ofsecond images based on the next trigger event according to someembodiments.

As shown in FIG. 8, a second bolus is injected to be imaged within thesecond set of images. However, if the injection of the second bolus isdelayed t_(bp0) from the next trigger event, the second bolus wouldtravel through a same section of vasculature during acquisition of thesecond set of images as was traveled by the first bolus duringacquisition of the first set of images. Accordingly, a next bolusinjection delay is determined at S770 in order to ensure that the secondbolus travels through at least a different section of the vasculatureduring acquisition of the second set of images.

The next injection delay may be determined as to shift the injection tooccur before the next R-wave. In some embodiments, the next injectiondelay is determined as: t_(bpN)=t_(cc)+t_(bp0)−(N*t_(bw)), where t_(cc)is the period of the cardiac cycle and N is the number of the cardiaccycle being imaged (the second cardiac cycle being number 1). Withreference to FIG. 8, t_(bp1) is illustrated as equal tot_(cc)+t_(bp0)−t_(bw). t_(bp1) is shown as measured from the firsttrigger event. Accordingly, flow returns from S770 to S720 rather thanto S710 to determine whether the injection delay time t_(bp1) hasexpired since the first detected trigger event.

Flow advances to S780 after a last set of images is acquired. Acomposite image is generated at S780 from two or more (e.g., all) of theacquired images. The composite image may be generated in any suitablemanner including but not limited to those described above with respectto S270. The composite image, in some embodiments, may provide anindication of the vasculature through which the bolus traveled duringacquisition of the images. The composite image may be stored amongcomposite images 27 of storage device 22.

A composite image generated according to some embodiments may includevisualizations which were not present in the acquired images, but whichmay be derived therefrom. For example, image 1000 of FIG. 10 includesimage 500 of FIG. 5 and vascular skeleton 1010 superimposed thereon.Skeleton 1010 may be determined by determining the centroid of eachrepresentation of the bolus within image 500 and connecting thesecentroids with lines or curves (e.g., splines). FIG. 11 illustratescomposite image 1100 including skeleton 1010 computed based on the bolusrepresentations of image 500 but not including the bolusrepresentations.

In another embodiment, time values may be represented on the vesselrepresentation (e.g., skeleton). The time values may indicate a time atwhich the bolus passed a respective position of the vesselrepresentation. FIG. 12 illustrates composite image 1200, in which colorand/or shading of a pixel of skeleton 1210 represents a time at which abolus (e.g., a centroid of the bolus) passed the portion of the vesselrepresented by the pixel. Any color and/or shading scheme/scale may beemployed according to some embodiments.

FIGS. 13 and 14 each illustrate a series of three looping image framesto illustrate movement of the bolus through the represented vasculature.Images 1300, 1310 and 1320 are cumulative and successively depict anincreasing period of time from injection of the bolus. Images 1400, 1410and 1420 each depict a respective exclusive time period from injectionof the bolus. Each image may be color-coded to represent times asdescribed with respect to FIG. 12.

FIG. 15 illustrates determination of an outer contour of the vasculaturethrough which the bolus has passed. Image 1500 includes the bolus imagesof image 500 and contour lines 1510 which may be determined therefromusing known image processing techniques. For example, edge detectionalgorithms may be employed to detect edges of each bolus image which areoriented in the direction of travel of the bolus (i.e., edges which aresubstantially perpendicular to the direction of travel may be ignored).The detected edges are then connected to create contiguous contours.

Image 1520 illustrates the contours 1510 without the bolus images. Avessel skeleton may be determined based on centerlines of the contours,rather than based on the bolus image centroids as described above. Thepixels of the contours may be color-coded to represent a time at whichthe bolus passed thereby as described with respect to FIGS. 12-14.

The skeleton, contour, and intensity information of theindividually-acquired images may be used to automatically generate aplot of vessel diameter at each vessel location. These diameters may beautomatically compared with diameter estimates of healthy parent vesselsto identify stenotic vessel segments. The contour may also be used as anoverlay graphic on a live fluoroscopy image to aid in diagnosis,planning, treatment, and assessment.

Also in view of the determined skeleton and/or the contour of thevessel, the intensity information of the individually-acquired imagescan be used to determine the amount of foreshortening present at anygiven point along the vessel tree. For example, if a shrinking of thebolus cross-section and an increase in bolus intensity is noted at acertain vessel location, it can be assumed that the bolus is moving inor out of the plane of the x-ray image at the location. Theforeshortening information may be indicated in a composite image (e.g.,as a color coding) along with the vessel skeleton and/or vessel contour.

An instantaneous velocity can be estimated for every bolus fragment byevaluating the distance traveled by the bolus between frames and thetime between frames. This velocity estimate can be improved by takinginto account foreshortening determined based on the change in area ofthe bolus fragments and the intensity values of the bolus fragments, asdescribed above. Moreover, abnormalities may be flagged at locations atwhich velocity is reduced but foreshortening is not detected. Thevelocity information may also be indicated in a composite image (e.g.,as a color coding) along with the vessel skeleton and/or vessel contour.

The above-described processes may be extended to three and fourdimensions. For example, some imaging systems (e.g., dual-arm systems)are capable of obtaining projection images at two or more differentprojection angles substantially simultaneously. Using such systems, aset of two (or more) images may be acquired during successive iterationsof S250, with each image of a set being associated with a respectiveprojection angles.

Next, at S270, a composite image is created for each projection angle.More specifically, for a particular projection angle, a two-dimensionalcomposite image is created based on the projection images which wereacquired at the particular projection angle. Thereafter, using knowntechniques, a three-dimensional image showing progression of the bolusthrough the vasculature may be reconstructed based on the two or morecomposite images.

The following is a description of automatic generation of athree-dimensional skeleton according to some embodiments. First, atwo-dimensional skeleton may be determined as described above for eachof two two-dimensional composite images associated with differentprojection angles. Based on the geometry of the imaging system, aposition of the first skeleton (associated with a first projectionangle) may be matched to one or more positions of the second skeleton(associated with a second projection angle).

A first timestamp is determined of the image frame acquired at the firstprojection angle in which the bolus first appears at the position of thefirst skeleton. Second timestamps are also determined of each of theimage frames acquired at the second projection angle in which the bolusfirst appears at the one or more positions of the second skeleton. Thesecond timestamp which most closely matches the first timestamp isidentified and its corresponding image frame determines the one of theone or more positions of the second skeleton which most closely matchesthe first position of the first skeleton. Using these two positions, acorresponding three-dimensional point can be identified. This processmay be repeated for other positions of the first skeleton, resulting inan automatically-generated three-dimensional skeleton.

Those in the art will appreciate that various adaptations andmodifications of the above-described embodiments can be configuredwithout departing from the scope and spirit of the claims. Therefore, itis to be understood that the claims may be practiced other than asspecifically described herein.

What is claimed is:
 1. A system comprising: a processing unit to: detecta trigger event; in response to detection of the trigger event,automatically inject a bolus of contrast medium into a patient volumeafter expiration of a predetermined injection delay period; in responseto detection of the trigger event, automatically acquire a plurality ofimages after expiration of a predetermined imaging delay period, two ormore of the plurality of images comprising an image of the bolus atrespective different locations within vasculature of the patient volume;and generate a composite image based on the plurality of images, thecomposite image including a representation of the vasculature of thepatient volume; and a display to display the composite image.
 2. Asystem according to claim 1, wherein each of the plurality of images isacquired at a predefined imaging interval, and wherein a distancetraveled by the bolus in the vasculature during the predefined imaginginterval is greater than a dimension of the bolus in the direction oftravel.
 3. A system according to claim 1, wherein generation of thecomposite image comprises: identification of a location of the bolus inthe two or more of the plurality of images; determination of a curveconnecting the identified locations; and generating a representation ofthe curve in the composite image.
 4. A system according to claim 3,wherein generation of the composite image comprises: identification ofopposite edges of the bolus in the two or more of the plurality ofimages; determination of an outer contour of the vasculature based onthe identified opposite edges; and generation of a representation of theouter contour in the composite image.
 5. A system according to claim 1,wherein generation of the composite image comprises: identification ofopposite edges of the bolus in the two or more of the plurality ofimages; determination of an outer contour of the vasculature based onthe identified opposite edges; and generation of a representation of theouter contour in the composite image.
 6. A system according to claim 1,wherein generation of the composite image comprises: determination offoreshortening at a location of the vasculature based on a decreasedsize of the bolus and an increase in an intensity of the bolus at thelocation in an acquired image as compared to a size of the bolus and anintensity of the bolus in another of the acquired images.
 7. A systemaccording to claim 1, further comprising: an X-ray detector and an X-raysource operable to acquire the plurality of images; and a contrastinjector to inject the bolus into the patient volume.
 8. A systemaccording to claim 1, wherein detection of the trigger event comprisesdetection of a peak of an R-wave in a cardiac signal, wherein theimaging delay period is based on a time between the peak and the startof an S-T interval of the cardiac signal, and wherein the plurality ofimages are acquired during an S-T segment of the cardiac signal.
 9. Asystem according to claim 8, the processing unit further to: detect asecond peak of an R-wave in a cardiac signal; automatically inject asecond bolus of contrast medium into a patient volume after expirationof a second predetermined injection delay period with respect todetection of the trigger event, wherein the second predeterminedinjection delay period is based on the period of the cardiac cycle, thepredetermined injection delay period and an expected width of the bolus;in response to detection of the second peak, automatically acquire asecond plurality of images after expiration of the predetermined imagingdelay period, two or more of the second plurality of images comprisingan image of the bolus at respective different locations withinvasculature of the patient volume; and generate a composite image basedon the first and second plurality of images, the composite imageincluding a representation of the vasculature of the patient volume. 10.A system according to claim 9, wherein each of the plurality of imagesis acquired at a predefined imaging interval, and wherein a distancetraveled by the bolus in the vasculature during the predefined imaginginterval is greater than a dimension of the bolus in the direction oftravel.
 11. A system according to claim 8, further comprising: an X-raydetector and an X-ray source operable to acquire the plurality ofimages; a contrast injector to inject the bolus into the patient volume;and a cardiac monitor to generate the cardiac signal.
 12. A systemaccording to claim 1, wherein the plurality of images are acquired froma first projection angle, and the processing unit further to: inresponse to detection of the trigger event, automatically acquire asecond plurality of images from a second projection angle afterexpiration of the predetermined imaging delay period, two or more of thesecond plurality of images comprising an image of the bolus atrespective different locations within vasculature of the patient volume;generate a second composite image based on the second plurality ofimages, the second composite image including a second representation ofthe vasculature of the patient volume; generate a first two-dimensionalskeleton based on the representation of the vasculature of the patientvolume; generate a second two-dimensional skeleton based on the secondrepresentation of the vasculature of the patient volume; and generate athree-dimensional skeleton of the vasculature based on the firsttwo-dimensional skeleton and the second two-dimensional skeleton.
 13. Amethod comprising: detecting a trigger event; in response to detectingthe trigger event, automatically injecting a bolus of contrast mediuminto a patient volume after expiration of a predetermined injectiondelay period; in response to detecting the trigger event, automaticallyacquiring a plurality of images after expiration of a predeterminedimaging delay period, two or more of the plurality of images comprisingan image of the bolus at respective different locations withinvasculature of the patient volume; generating a composite image based onthe plurality of images, the composite image including a representationof the vasculature of the patient volume; and displaying the compositeimage.
 14. A method according to claim 13, wherein each of the pluralityof images is acquired at a predefined imaging interval, and wherein adistance traveled by the bolus in the vasculature during the predefinedimaging interval is greater than a dimension of the bolus in thedirection of travel.
 15. A method according to claim 13, whereingenerating the composite image comprises identifying a location of thebolus in the two or more of the plurality of images; determining a curveconnecting the identified locations; and generating a representation ofthe curve in the composite image.
 16. A method according to claim 15,wherein generating the composite image comprises: identifying oppositeedges of the bolus in the two or more of the plurality of images;determining an outer contour of the vasculature based on the identifiedopposite edges; and generating a representation of the outer contour inthe composite image.
 17. A method according to claim 13, whereingenerating the composite image comprises: determining foreshortening ata location of the vasculature based on a decreased size of the bolus andan increase in an intensity of the bolus at the location in an acquiredimage as compared to a size of the bolus and an intensity of the bolusin another of the acquired images.
 18. A method according to claim 13,wherein the detecting the trigger event comprises detecting a peak of anR-wave in a cardiac signal, wherein the imaging delay period is based ona time between the peak and the start of an S-T interval of the cardiacsignal, and wherein the plurality of images are acquired during an S-Tsegment of the cardiac signal.
 19. A method according to claim 18, thefurther comprising: detecting a second peak of an R-wave in a cardiacsignal; automatically injecting a second bolus of contrast medium into apatient volume after expiration of a second predetermined injectiondelay period with respect to detection of the trigger event, wherein thesecond predetermined injection delay period is based on the period ofthe cardiac cycle, the predetermined injection delay period and anexpected width of the bolus; in response to detecting the second peak,automatically acquiring a second plurality of images after expiration ofthe predetermined imaging delay period, two or more of the secondplurality of images comprising an image of the bolus at respectivedifferent locations within vasculature of the patient volume; andgenerating a composite image based on the first and second plurality ofimages, the composite image including a representation of thevasculature of the patient volume.
 20. A system comprising: a cardiacmonitor to generate a cardiac signal based on electrical signalsreceived from a patient; an x-ray detector and an x-ray source operableto acquire x-ray images; a contrast injector to inject a bolus ofcontrast medium into the patient; and a processing unit to: receive thecardiac signal from the cardiac monitor, detect a peak of an R-wave in acardiac signal, wherein the plurality of images are acquired a triggerevent; in response to detecting the peak, automatically injecting thebolus of contrast medium into the patient after expiration of apredetermined injection delay period; in response to detecting the peak,automatically acquiring a plurality of images during an S-T segment ofthe cardiac signal in response to expiration of a predetermined imagingdelay period, the predetermined imaging delay period based on a timebetween the peak and a start of an S-T interval of the cardiac signal,where two or more of the plurality of images comprise an image of thebolus at respective different locations within vasculature of thepatient; and generate a composite image based on the plurality ofimages, the composite image including a representation of thevasculature of the patient; and a display to display the compositeimage.